Permit CITY OF TIGARD PLUMBING PERMIT
11 COMMUNITY DEVELOPMENT Permit#: PLM2021-00155
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/15/2021
Parcel: 2S102CB07300
Jurisdiction: Tigard
Site address: 10400 SW PARK ST
Project: Oregon Children's Academy Subdivision: 1998-084 PARTITION PLAT Lot: 1
Project Description: Replace existing backflow preventer
Contractor: SR JOHNSON PLUMBING INC Owner: ANAEF LLC
PO BOX 100 BY ANNE FERNANDO
CANBY, OR 97013 18240 MEADOWLARK LN
LAKE OSWEGO,OR 97034
PHONE: 503-266-7885 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/15/2021 $31.27
Specifics: 1 12%State Surcharge- 04/15/2021 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 04/15/2021 $41.23
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: %,in (a n Permittee Signature: 7Y� ,�..'1pptc,ca6-
[� U �1 t
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Apnlica ECEIVED - 4 G 21
Building Fixtures FoR t)FFICP: I.SF O\I l
APR E 2021 t� �f'
` City of Tigard Received Permit No.:{ LM?OZ,1,'oD I�J-.�
: / ■ 13125 SW Hall Blvd.,Tigard,OR 9 �/ Plan Re. (� ( I t'
Phone: 503.718.2439 Fax: 503.5019600E TIGA�iU Plan Other Permit No.:
Inspection Line: 503.639.4175 i3UILDING DIVISION 1lateRe
T I G A R D Date Ready/By: �-f hair: 0 See Paget for
w Internet: ww.tigard-or.gov Notified/Method: I t!( Supplemental Information
TYPE OF WORK - - FEE* SCHEDULE
0 New construction ❑Demolition Far special information use checklist
Description I Qty. I Ea 1 Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath ' 312.70
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath 500.32
0Multi-family
Each additional bathlkitchen 25.02
❑Master builder 0 Other: Fire sprinlder(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ,)400 sw -Jik,�,V -t- Catch basin or area drain 18.76
A�� O v, Drywell,leach line, trench drain 18.76
City/S[atelZlP: cogs/
I Footing drain(no.linear
ar ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item: q
Tax map/parcel no.: Bau:kflow preventer t 31.27 ,J.d9
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
tsfi nh r JPaL 31�t',kt> en r Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I TENANT Expansion lank 12.51
Name: Q� B 5Sita_kk Fioo rdscwcr cap r
Fr drain/floor sink/hubI
Address: ' ({ a _ k oGarbage disposal 25.02
City/State/ZIP: •J 1\ 1 / (AL. 6/)AP 3 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT CONTACT PERSON In�ePtor/Sca �seP t
Business name: S • . �6,,A,,fx, 4�t,,•(3,.." t +�. Primer
Contact name: iti l gas(value:$_) 12.51
_
n0 J Romer
Roof drain(commercial) 12.51
bAddress:- e } I 42)
Sink/basin/lavatory 25.02
City/State/ZIP: CA..v. Cu 11 b j 3 Solar units(potable water) 62.54
Phone:(sir., )614 .t 11 Fax::( ) Tub/shower/shower pan 12.51
� ptt Urinal 25.02
E-mail: Ran �Q���GA CQJ ll Water closet 25.02
CO
�n Water heater 37.52
RACTOR
Business name: S. 1a. SDhnsw- -V lutwv -,ne . Water tP
in WV 56.29
i
Address: -Pb tor,
Other. 25.02
City/State/ZIP: el/ b(A, g/Tp)3 Subtotal
Li Phone:(C�3)avto Li_ -7�fi�� Fax:( ) Minimum permit fee: I
�]t� AA 2-���� Plan review (25%of penult tee)
CCB Lic.: �'I 4,2 rr __ Plumbing Lic.no.: 3 tY State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE 1)12•
-
Print name:62.___ Date:L.(/40 I This permit application expires Ea permit is not obtained within 130 days
after it has been accepted as complete.
*Fee methodology sct by Tri-County Building Industry Service Board.
I:lauidingiPermits1PLMU-PermitApp.doe 10N1109 440.4616T(10(02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1"100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 3,601 to 7,200 $23320
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62•54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' b2.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5 .52 for
,001.00 to$10,000.00 $72.50 for the each additionalfirst
100.00 or fraction lthereof,to
Other Inspections or Fees Qty• Fee(ea) Total and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$154 for
which no fee is specifically indicated 90.00/lu each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof to
Reinspection Fees 90.00/hr and including$50,000.00.
90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" Isometric or Riser Diagram
-3"
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related _
-Commercial food related
-Industrial food related Comments regarding fixture work:
•
lee Mach./Refrig.Drains I�.1.-/� 1 1 `✓-� .,Ll, 1Q.Q G� ,vi,r4
Oil Separaatortor(Gas Station)
_Rec.Vehicle Dump Station
Shower. -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley •
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Closet-Toilet
Urinal
_Other Fixtures:
I:\Building\Permits\PLMF_PemtitApp.doc 08/04/2011 2